Tuesday, December 29, 2015

Developing an accurate prognosis, i.e., predicting how a man’s cancer is likely to behave in the future, is the first and most important step toward optimal care. Future predictions are often looked at with some suspicion. With prostate cancer, however, our power to anticipate future cancer behavior is quite accurate unless there is a lack of thoroughness in gathering information.

The Size of the TumorTumor size is a universally important prognostic sign for almost all types of cancer including prostate cancer. The method for incorporating tumor size into the Anthony D’Amico’s staging system relies on the degree of PSA elevation, the tumor grade and on how the prostate "feels" with the finger of a trained practitioner. These indicators are useful but don’t incorporate information from modern imaging. Imaging provides accurate information about tumor size and the presence or absence of extracapsular extension. These are very powerful prognostic predictors and it would be foolish to disregard their importance. As things stand presently these indicators are often used to divide the low, intermediate and high risk categories into "favorable" and "unfavorable" subcategories, each with a different spectrum of recommended treatment options.

Knowing Past Treatments Tells Something about Future PrognosisHistorically, since the total number of available treatments is relatively limited, practitioners have used a sequential "trial and error" treatment methodology that administers the standard treatment options in a fairly predictable sequence. For example, it is not uncommon for men to start with surgery or radiation. When a relapse occurs, standard hormone therapy (Lupron) is often started and given intermittently or continuously. Hormone therapy usually controls the disease for an average of 10 years. When Lupron stops working, immunotherapy with Provenge is usually follows. After Provenge, more potent hormone therapy with Xtandi or Zytiga is started. If these two agents prove ineffective, chemotherapy with Taxotere or radiation with Xofigo would be considered next.

The whole point of presenting the treatment sequence described in the previous paragraph is to convey the idea that the number of previous treatments communicates important information about that patients’ future prognosis. Having "failed" Lupron, for example, bespeaks of a much more worrisome prognosis compared to the situation where Lupron continues to be effective.Response to Lupron, The Mother of All Metrics
The quality of the "response" to Lupron is actually one of the most powerful prognostic metrics available. The degree of PSA decline after Lupron is incredibly important. How low the PSA drops after starting Lupron is called the "PSA nadir." The specific PSA threshold used to determine a "good response" is less than 0.1. Believe it or not, there is a huge difference in prognosis between a man on Lupron for six months who has a PSA of 0.1 versus a man whose PSA levels off at 1.0.

An Established History is also a Prognostic Indicator
Another somewhat obvious prognostic indicator that is often overlooked and almost never discussed in textbooks has to do with the prognosis of men who have been diagnosed years ago -- over time it is apparent that things are turning out much better than what might have been expected based on their initial indicators. For example, take the case of a man who started off with a panoply of bad indicators—tumor is in the lymph nodes and Gleason 10—but after aggressive treatment remains in remission for 5 years. The fact that things have gone well for five years counts bigtime in his favor going forward. Remember, the original prognostic predictors of a Gleason 10 were just that, predictors. No predictor is 100% accurate. Five years of established history is a stronger predictor than the original Gleason score. The fact that things have gone well for five years, strongly indicates that the future is for that individual is bright. Such individuals have "beaten the odds."
The Location of the Tumor in the Body
Another extremely important indicator of prognosis, something that even laypeople anticipate by simple common sense, is the location of the cancer in the body. Location says volumes about how things are likely to progress in the future. For example, consider the following sequence of progressively more serious cancer sites:

•Contained within the prostate
•Extended into the seminal vesicle
•Spread to the lymph nodes
•Bone metastases
•Liver metastasis

Each of these locations is very important for determining prognosis.

This short blog is just an introduction to some of the "profiling" methods utilized in generating an accurate prognosis. Space limitations preclude discussion here about other known prognostic factors such as the size of the prostate gland (discussed in a previous blog), genetic tests and PSA doubling time. The D’Amico risk categories constitute the backbone of useful prognostic information. However, the additional prognostic information beyond the D’Amico risk categories that are discussed in this blog, provide additional useful information necessary for determining an accurate prognosis. An accurate prognosis is the starting point for accurate selection of treatment.

Tuesday, December 15, 2015

Dr.Kevin Nead authored an article published in the Journal of Clinical Oncology this month.It created a media
sensation and generated multiple calls to the PCRI Helpline. Last week, three separate articles about this
topic were posted on the Yahoo home page at the same time.

It’s
no surprise that an article on this topic generates wide-spread interest. About
500,000 thousand men in the United States are undergoing prostate cancer
treatment with androgen deprivation therapy (ADT). This treatment works by blocking
the male hormone levels delivering notable anticancer efficacy and also proven
to prolong life in men with prostate cancer. Despite it’s known effectiveness, a
variety of side effects can occur, including memory problems.The previously reported studies evaluating this
phenomenon seem to indicate that when memory deficits occur, they usually
reverse after ADT is stopped.The
research published in the Journal of Clinical Oncology, relied on a new method
of searching through patient’s medical charts with computers. No human review
of these medical charts were performed. The computer software searched the medical
records in an attempt to determine if men on ADT had a higher incidence of
Alzheimer’s. The authors report that this new computer searching methodology in detecting a specific medical diagnosis is 74% accurate.

Review
of all the charts at Stanford and Mount Sinai hospital unearthed 16,888 prostate
cancer patients of which 2,397 were treated with ADT.After the fancy computer analysis, designed to
compensate for multiple factors such as patient age and underlying heart disease
(both of which lead to Alzheimer’s more frequently), the conclusion was that
the ADT-treated men were twice as likely to have developed Alzheimer’s. A total
of about 9 cases would have been expected from normal causes, but 18 were
actually detected. If these conclusions
are accepted as gospel truth, an additional 9 out of 2,397 men treated with ADT
would equate to an increased risk of less than half of 1%.

The
conclusion that there is tiny increase risk of Alzheimer’s with ADT, needs to
be put in context based on what we already know about prostate cancer. First,
is it possible that these men have reversible
memory problems while still taking ADT? There was no attempt in the study made
to determine if the “Alzheimer’s” patients were still on ADT when the diagnosis
of Alzheimer’s was made. Second, men treated with ADT are substantially sicker
than men who don’t need ADT.There is no
way for the computer analysis to compensate for how this may have impacted mental
performance. Third, patients getting ADT receive closer medical surveillance
and visit physicians more frequently than men who are not receiving ADT.As such, memory problems are more likely to
come to medical attention and be diagnosed when men are on ADT. Fourth, general
anesthesia (from surgery) is known to cause long-term memory problems.This study did not perform any analysis to
determine if surgery was performed with equal frequency in both groups.

In
summary, it is not clear from this JCO article whether the men labeled having Alzheimer’s
disease had memory problems while still receiving ADT or whether they had true
Alzheimer’s, i.e., long-term irreversible memory problems continuing after the
ADT was stopped. There is one thing, however, this study does show: At worst,
memory problems serious enough to be labeled as “Alzheimer’s” occur in in less
than one out of every 200 men treated with ADT.

Tuesday, December 1, 2015

Cancer
that spreads outside the prostate gland is what makes prostate cancer
dangerous. Metastatic prostate cancer cells cause malfunction by impeding
normal function. Some organs, like lymph
nodes for example, continue to function quite nicely, even if the degree of
cancer spread is extensive.Lymph node
spread, therefore, is the least dangerous form of prostate cancer
metastases.At the other end of the spectrum
is the liver, which is far less
tolerant.The seriousness of bone metastases, the most common site of
prostate cancer spread, lies about half way between that of node metastases and
liver metastases.

The
earliest stages of metastases are microscopic and therefore invisible even with
the best available technology. To be detected with the best available PET scan
technology, small tumors must measure more than 1/8 of an inch across. For
detection with standard CT scans and MRI scans, more than a half-inch sized
tumor is necessary. Since the presence of metastases is such a defining issue
when describing a cancer’s character, men who are newly-diagnosed are labeled
as low, intermediate or high-risk depending on their estimatedlikelihood of
micro-metastatic disease. Liver metastases are extremely rare at the time of
initial diagnosis of prostate cancer. When they occur it is usually after many
years of ongoing treatment for known metastatic disease in the bone.

Prophylactic
treatment with hormone therapy, chemotherapy or radiation to treat the possibility of micro-metastases is
common for high-risk prostate cancer and occurs maybe half the time in
intermediate-risk prostate cancer. The goal is to cure the micro-metastases at
an early stage when they are most susceptible to eradication, thus preventing
the future development of detectable metastases which is what makes cancer life
threatening.

When
talking about prostate cancer, even though this is a blog about metastases, it
should always be remembered that many common types of prostate cancer never
spread. These low grade “cancers” are genetically distinct and represent a
totally different category of disease.However,
when discussing the type of prostate cancer that is capable of metastasis, the
following factors impact how dangerous it is:

The site of spread.

The extent of spread

The tumor cell growth rate

The efficacy of available treatment

As
noted above, the liver is far less tolerant to metastatic invasion than bone or
lymph nodes. In addition, because liver metastases tend to occur in men with advanced
disease, tumor growth rates tend to be brisk. Also, the most commonly
administered treatments, hormone therapies and chemotherapy, have often already
been tried before liver metastases first develop. The advent of liver
metastases, therefore, usually represents a very serious and life threatening
issue.

Liver
metastases may first be suspected when standard blood tests such as ALT, AST or
ALP which are components of a hepatic panel blood test, register outside the
normal range. Investigation into their cause often leads to doing a CT scan or
MRI scan of the abdomen and pelvis to confirm the presence of disease in the
liver. Alternatively, a scan may detect abnormal spots in the liver during
routine periodic scanning that is being performed as regular surveillance.

Hormone
therapy with Lupron, Zytiga and Xtandi, or chemotherapy with Taxotere, Jevtana
and Carboplatin, is the standard approach to treatment for liver
metastasis.However, these treatments
may have already been tried or may no longer be effective.Since liver failure is tantamount to death,
prostate cancer growth in the liver needs to be stopped immediately, regardless
of how the disease is faring in the bones or nodes.

Much
that has been learned about the treatment of liver metastases comes from
reviewing common methods for managing metastatic colon cancer. The liver is the
cancer’s preferred site of metastatic spread for colon cancer. Treatments that
have been employed include surgery, radiation and blockage of the blood supply
to the liver by embolization of the arteries, all with variable success.More recently, radioactive microspheres
injected directly into the tumor, called SIR-Spheres, have shown notable
efficacy with very tolerable side effects.

Prostate
cancer and colon cancer are similar in that they are both adenocarcinomas which
means they are derived from glands. Therefore, they are likely to have similar
susceptibility to radiation. As such, we have been administering SIR-Spheres to
a limited number of prostate cancer patients with liver metastases. Results
have been encouraging with a notable improvement of survival compared to our
historical experience treatment patients with liver metastases without SIR-Spheres.Our preliminary results using SIR-Spheres in
six patients is being presented at the 2016 Genitourinary Cancers Symposium - San Francisco in January 2016.

Tuesday, November 24, 2015

A recent UCLA
study found that a significant percentage of men diagnosed with low-risk
prostate cancer who chose "active surveillance," rather than
aggressive treatment in order to avoid the debilitating side effects of surgery
or radiation, don't follow up with the required tests and office visits.

This is
an alarming finding, because not being monitored appropriately puts them in
danger of the cancer progressing or metastasizing without their knowledge.
Before patients decide on active surveillance as a management option for
prostate cancer they should agree with their physician on a strict follow-up
schedule to closely monitor the cancer.

There is
no doubt in my mind that active surveillance is the smart treatment option for
low-risk prostate cancer. With other cancers, or if the prostate
cancer is aggressive, the main issue is survival. But with low-risk prostate
cancer, since long survival is the norm, the most important consideration
is quality of life. Having said that, with active surveillance regular
check-ups are essential, because when men are watched closely, treatment can be
started at the first sign of cancer progression.

So what
does active surveillance require? How exactly is it carried out?

Different
centers have different requirements. At a 2007 Active Surveillance Conference,
attended by over 200 of the world's leading prostate cancer experts, the
attendees recommended a biopsy after one year, subsequently repeating it every
two to three years. But as I have often said, I am not a fan of biopsies. So I
prefer to recommend doing a repeat targeted biopsy only on the basis of a PSA and
prostate imaging with either color Doppler ultrasound or 3T multi-parametric MRI.

Whatever
protocol your urologist recommends you need to be committed to following it. It
may be inconvenient or uncomfortable but the alternative is aggressive
treatment that has the potential to leave you with erectile and urinary
dysfunction.

There is
always the consideration to just treat the cancer and be rid of it. But having
lived with this disease for over two decades, with my prostate intact, I am a
firm believer in avoiding radical treatment and preserving quality of life as
long as possible. And if you have low-risk prostate cancer, bear in mind
that the longer you can wait before you submit to radical treatment, the better
the odds are that research in the field will have advanced, and treatment will
have become more effective and less
toxic.

Tuesday, November 17, 2015

BY MARK SCHOLZ, MDIn 2016, the PCRI will celebrate its 20th
anniversary.The PCRI, founded in 1996
by Dr. Stephen Strum and I, was originally funded by a generous grant from the
Daniel Freeman Medical Foundation.This
initial grant was spent on hiring Harry Pinchot, aka Helpline Harry. The
helpline format adopted at the PCRI was modeled after the work of Lloyd Ney,
the founder of PAACT.PCRI’s helpline presently has four counselors: Jonathan Levy, Silvia Cooper, Bob Each and
Charles Kokaska, all who provide unbiased prostate-cancer-related information,
free of charge to the public.

PCRI started doing patient-focused
conferences in 2006. Since 2006 this has become an annual meeting. The conference
has grown in stature through the years by attracting world-renowned prostate
cancer experts who are invited to present the latest information on optimal
diagnosis and therapy. DVDs of the presentations are distributed throughout the
world. Partly due to the wonderful moderating presence of Dr. Mark Moyad, the
conference has grown to be the largest patient-orientated prostate cancer
conference in the world.

PCRI makes its biggest impact via its online
presence by providing articles and blogs authored by prostate cancer experts
from every specialty. But more importantly, PCRI is presently in entering into
a new phase, the development of the SHADEs of Blue organizational format, a
methodology to help patients sort through the overwhelming amount of information
by reducing it into a more manageable bite-sized format.As we all know, the internet has solved the
problem of getting access to information.Now the biggest problem patients face is information overload. How does
one sort through the deluge of unfiltered information?

The development of the SHADES of Blue program
will address this problem of information overload by segregating prostate
cancer information into five large categories. Three are for the
newly-diagnosed, Low, Intermediate and High-Risk, and two are for men with
either relapsed disease or metastatic, hormone-resistant disease. The SHADES
program is a big undertaking for a small organization like the PCRI, especially
considering that we have expanded our conference schedule by now doing two
conferences annually with the addition of the Mid-Year Update in March.

Looking to the immediate future, I never been
more excited by the PCRI’s potential for making a positive impact in the lives
of men with prostate cancer. If my suspicious are correct, PCRI’s
visibility is truly on the verge of taking a big jump.

Tuesday, November 10, 2015

Following in the footsteps
of robotic surgeons, prostate cancer continues to go high-tech. Radiation, for
instance, is no longer just radiation. There are now numerous different ways to
deliver it. But the two methods I want to write about here are Intensity
Modulated Radiation Therapy (IMRT), and Proton Beam Therapy (PBT).

The predominant method in
the U.S. for the past decade is IMRT, a complex procedure that precisely
targets the prostate gland with multiple beams of high energy light (photons)
at different angles and intensities while significantly lowering the risk of
damage to the surrounding tissues and organs. This greater accuracy
in targeting also allows the therapist to maximize the radiation dose to the
tumor. IMRT has at least as effective a cure rate as surgery, and without the
risks and side effects of a major surgical procedure.

Having said that, I have
recently been checking out Proton Beam Therapy, a form of radiation that
targets the tumor with charged particles called protons. Several decades ago,
Loma Linda University in California was the first to begin administering PBT.
At that time, I had a friend who, at 55, developed prostate cancer and was one
of the first patients at Loma Linda when proton therapy was at a very early
stage. Bill has been free of cancer for over twenty years, and only recently
had a rise in PSA and is discussing further treatment.

Since then, thanks in part
to marketing hype, PBT is becoming increasingly popular. Now, M.D. Anderson,
Harvard, and the University of Florida in Jacksonville, are among the major
medical centers that have made PBT available. And The Mayo Clinic is
building two proton therapy centers (one in Rochester, one in Arizona) at
a cost of $380 million. Naturally PBT costs considerably more than IMRT.

When weighing treatment
options, patients generally consider two main factors: potential side-effects,
and successful outcome. So how do these two therapies measure up? Well, there
is considerable controversy in the urologic community. The good news is both
therapies have a high cure rate. Studies that have tried to compare IMRT with Proton
therapy indicate that the outcomes are quite similar and that the side effects
are comparable. No large randomized trials have been published that directly
compare patient outcomes with the different techniques. So in the end, a
treatment decision usually depends on such variables as patient preference and
doctor preference.

It is reasonable,
therefore, to keep in mind that any medical center that has invested an
astronomical amount of money on equipment will end up wanting to use it.

Tuesday, November 3, 2015

BY MARK SCHOLZ, MDProstate
cancer is way over treated, and the problem starts with over diagnosis.Once men are diagnosed, the fear of cancer
naturally drives them toward radical treatment. In 2011 the US Preventive
Services Task Force intervened, trying to stop overtreatment, argued that PSA
testing causes more harm than good.Some have
questioned the expertise of the panel because of the lack of representation by
urologists, radiation therapists or medical oncologists --the types of doctors
usually responsible for treating prostate cancer.Actually, the credentials of the panel
constituents appear entirely appropriate to comment on screening, because this
is an area of medicine usually handled by primary care doctors.The panel members consisted of twelve MD’s
and four PhD’s trained in primary care, public health and statistics.

The Task Force
agrees that PSA screening may save lives. Their judgment, however, was that too
few lives are saved to justify thousands of men getting unnecessary radical
treatment. One statistic indicates that a thousand men must be screened to save
one life within the next 12 years.

Personally, I
agree with the panel in regards to over diagnosis is a root cause of over
treatment. However, simply discarding PSA is an oversimplification. PSA can
detect a variety of problems infection and benign prostate enlargement. Actually,
the majority of men with elevated PSA, don’t have prostate cancer.No, the real
problem is after a PSA test rises. Every
year, a million men are advised to have a dozen, large-bore needles jabbed into
their rectums “Just to be sure there is no cancer.”Such behavior sounds ridiculous, but really,
it is just the survival instinct in action. People will do practically anything
when they fear for their lives.So if not a
biopsy to evaluate an elevated PSA, what’s next? First, the
fear must be faced. Ralph Waldo Emerson says “Knowledge is the antidote to
fear.” So let’s look at some basic facts:

One out of 38 men die of prostate cancer

One out of seven men are diagnosed with prostate cancer

In men who are “diagnosed”

Five-year survival is 100%

Ten-year survival is 99%

Fifteen-year survival is 94%

Considering it
is cancer, survival rates are great! At least these numbers should overcome any
urge to rush. Clearly there is plenty of time is to study and learn more. Confusion
arises because a minority of prostate cancers can indeed be dangerous. Not as
dangerous as lung or pancreas cancer which kill within months. However, demise
from prostate cancer certainly qualifies as “dangerous,” even if it is rather
infrequent and much postponed.These
statistics reveal something else that is quite useful. Prostate management
issues are of long-range nature, like
saving for college or for retirement. Just as expert financial planners are
limited in the ability to make predictions about economic activity ten years in
the future, doctors should be equally humble in their pronouncements about the
future of prostate cancer. We don’t know for sure, but we strongly suspect
there will be substantial breakthroughs in the diagnosis and treatment of
prostate cancer in the next ten years.

For the short
term, I think the best way to proceed is with imaging the prostate with a 3Tmulti-parametric MRI or color Doppler ultrasound. Scans are about as accurate
as a random biopsy for detecting aggressive cancers and they usually fail to
detect the harmless low grade types, which is a good thing. However, if there
is a worrisome abnormality, a targeted biopsy with just a couple cores is
needed.

Over-diagnosis
and over-treatment is not due to PSA. It’s the misguided policy of rushing into
an immediate random biopsy whenever there is a slight elevation. .The random biopsy procedure should be
abandoned. PSA abnormalities should be
evaluated with prostate imaging A targeted biopsy can be considered in men who
have a distinct abnormality detected by imaging.

Tuesday, October 27, 2015

Back into the mists of time, year after
year, in our unending struggle to protect ourselves against sinister and deadly
invaders, we expend our energies, our wealth and our physical strength to
survive and maintain our health. One mysterious and potent ally is the Anger
Response. The Anger Response system is not unique to our bodies. Parallel forms
of this “homeland defense” can be identified at all societal levels: of the
family, the community, of nations.

However, like any effective and powerful
resource, over-reliance is a potential pitfall. Over dependency on the use of
anger as a problem-solving-mechanism leads to an angry persona. “As a people
thinketh” certainly applies. So the
loose bundle of platitudes and commonplace aphorisms pertaining to sending healing,
loving messages, really needsto
become SOP, “Standard operating procedure.”

What a daunting privilege! Swing high
enough on that swing and you are led, inevitably, inexorably, to thoughts of
Our Creator, to the God of our Understanding . . . in whose image we are said
to be fashioned. We have the free choice to send messages of hate and fear or
messages of healing and love. And so we communicate with the rest of the planet.
Words come back to me, my mother frustrated and distressed, me about 25, her
launching, “Your whole modus operandi is rotten to the core.” Not even certain
she could define modus operandi. It
was a phrase she picked up from my father.

As advice for Rageaholics, I
remember various of my elders advising me to “stop and think” before I blasted
off. Well, here are five questions to teach small boys to ask themselves, to
determine, or “profile” who they are at any given moment. Five questions to
answer when they can catch themselves in the act of feeling angry:

1) Is it true?2) Is it helpful?3) Does it inspire?4) Is it necessary?

5) Is it kind?

A tremendous communication
tool, serves as a referee for our impulses, and allows an opportunity for us to
work through a kind of a checklist re. who
we want to be—what compliment of qualities would we want present in this
moment, qualities that will allow us to operate (and “cooperate” to match our
destiny) in most positive and uplifting way. I have a growing taste for
acronyms. Well there’s a good one: The acronym (what a pleasant surprise) is
THINK.

Tuesday, October 20, 2015

It’s time to change our
preconceptions about prostate cancer and “reboot”
the way we think about what typically is a non-life-threatening disease. Ever
since the FDA first approved PSA testing in 1987, prostate cancer has grown
into an aggressive multibillion dollar industry. Marketing hype has created the
impression that treatments like Proton therapy and robotic surgery are
universally desirable, even though well-informed patients know this is hardly
the case.How did the prostate cancer
world deviate so far off the originally intended tract of helping patients? And
what can be done to set things straight?Ten years ago the experts believed that
immediate curative treatment was needed for every man with prostate
cancer.Today, after 20 years of
vigorously detecting and treating every case of prostate cancer, it has become
clear that almost half of the 230,000
men diagnosed every year are undergoing radical treatment for a cancer that is incapable
of metastasizing.Now it’s time for the
medical community to come to grips with the fact that over a million men in the
United States are living with impotence and incontinence for no justifiable
reason. This is a disaster of gargantuan proportions.Shockingly, even though we can now readily
identify these harmless cancers, the problem of rampant overtreatment continues.
In 2015 another 50,000 men will undergo unnecessary radical treatment. The
medical industrial complex that has been gaining momentum for 25 years refuses
to confess its tragic errors.The huge
investments in enormously expensive medical equipment need to be paid off. No
one is willing to accept responsibility, make apologies or confess wrongdoing
for all the overtreatment.The existing system
is entrenched and the doctors are too comfortable with the status quo.Reversing the momentum of twenty-five years
of recommending unnecessary radical treatments is going to require the patients
to protect themselves.They need to become
far more medically sophisticated consumers.Five years ago, Ralph Blum and I fired the first salvo by writing Invasion of the Prostate Snatchers: No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency. In our
book, we attempted to defang the poisonous and fear-inducing word cancer
by renaming the low-risk type that does not metastasize “The UnCancer.”Our book has been helpful at revamping the
gross misconception that every prostate cancer is potentially deadly.Invasion provides an excellent introduction
to men with newly-diagnosed cancer by presenting the important concept that
prostate cancer comes in three broad types: low, intermediate and high-risk.

One of the important themes introduced by Invasion
is a healthy mistrust of physician motives. For protection against patients
receiving the wrong treatment, Invasion argues strongly for patient
empowerment through education. The term,
“prostate cancer” is merely an umbrella term for a broad spectrum of illnesses
that behave very differently. The book simplifies the treatment decision making
process by clearly identifying the three major subtypes of prostate cancer,
low, intermediate and high-risk.Once patients
have gained an accurate understanding of where they fit into this
individualized schema, an informed treatment decision can be made. As a medical
oncologist, rather than a surgeon, the information provided in the book is unbiased
with clear presentation of all the risks and benefits associated with all the
different treatments that are available.In an era now past, physicians were trained
to put their patient’s interests ahead of their own.Today, patients need to adopt defensive
tactics that are realistic about how prostate cancer care has become a highly
lucrative business. The patient who assumes that their counseling physician
represents his best interests, is on the cusp of making a dangerous mistake. Bluntly,
the prostate cancer world has evolved into a sophisticated and well-oiled
business and the buyer better be on guard.

Tuesday, October 13, 2015

Whether you are newly diagnosed with prostate cancer, or coping with bone metastases, learning about chronic stress and its negative impact on your body is almost as critical to your healing as whatever treatment you choose.

Short-term stress, a single episode of acute stress, generally doesn't cause problems. However, chronic emotional stress, caused by situations or events that last over a period of time, takes a significant toll on the body. Furthermore, this kind of prolonged stress suppresses the immune system, profoundly affecting its ability to detect defective or cancerous cells and destroy them.

Persistent feelings of fear, anxiety and unrelieved stress trigger the fight-or-flight response system that our ancestors relied upon. When a threat is recognized, heart rate and blood pressure skyrocket, sugar pours into the blood, muscles tense for quick action, and the whole metabolism goes into survival mode. This is great if you're on the African savannah and you hear a lion growling outside your tent. However, Nature never intended this "On your mark! Get set! Go!" response to last more than a moment or two. So when the brain sends a threat message for which there is no swift resolution, the fight-or-flight system stays stuck on "Get set!." As a result, the immune system is locked into protection mode and is no longer capable of performing the remedial function that is our most powerful defense against cancer.

So when we feel unable to manage or control the changes in our lives caused by prostate cancer, it not only reduces our quality of life, but it is associated with poorer clinical outcomes. In fact, studies in mice, and in tests in human cancer cells grown in the laboratory have found that prolonged psychological stress can enhance a tumor's ability to grow and spread.

There is always the temptation to alleviate the stress overload of a potentially life-threatening diagnosis with risky behaviors such as drinking alcohol in excess, taking drugs, and over-eating. But this kind of "stress management" only further inhibits immune function. However, maintaining a healthy lifestyle—which means eating well and staying physically active--supports the immune system. As do coping strategies such as relaxation techniques, meditation, yoga, and visualization. And don't forget laughter—the ultimate antioxidant.

Here's how the Discovery Health Web describes the impact of laughter on the immune system: "When we laugh, natural killer cells which destroy tumors and viruses increase, along with Gamma-interferon (a disease-fighting protein), T cells (important for our immune system) and B cells (which make disease-fighting antibodies). As well as lowering blood pressure, laughter increases oxygen in the blood, which also encourages healing."

So find out what works for you so that stress does not get the best of you. If you can’t seem to get a handle on it, laugh your way back to health!

Tuesday, October 6, 2015

BY MARK SCHOLZ, MDBuilding
up a medical practice and getting a late start with a family, my midlife crisis
was delayed past the usual occurrence for men in their early 40s.However, by the time I hit 50, self-questioning was starting to surface. My life had meaningful pursuits but
it was time to take a deep breath and do the traditional life inventory of the
“mid-years,” to reassess my goals for the last third of my existence here on
planet earth.After
reflection, I realized that I really didn’t have any great ideas to reinvigorate
my passion for the last lap. I couldn’t sell my wife on the idea of buying a
Lamborghini (I already owned a small boat).I didn’t have any specific desire to travel.I had given up on golf due to a terrible and
uncorrectable slice.I have never been
successful playing the stock market. All
these considerations were going through my head about ten years ago.Now ten years later, I turned
60 and I feel revitalized and reinvigorated.So what turned things around?

Many
of you have come to know Ralph, my coauthor in the Snatchers Blog. He is as a
sensible dispenser of advice and knowledge about life and about prostate
cancer. I first met Ralph almost fifteen years ago, first as a patient,
subsequently as a writing teacher and now as a writing partner. As I reflect
back over the years that we have worked together I am convinced that its Ralph who
spared me from my mid-life crisis.Don’t
get me wrong, I have a lovely family. My wife Juliet is a bulwark of
truth.My children are delightfully sensible, talented and hard-working. I am also blessed
with an amazing medical practice with wonderful coworkers and extra-special
patients.Even
so, visiting with a dozen men a day, five days a week, year after year, decade
after decade can wear you down. Getting paid less and less every year while the
work load steadily increases is hardly inspiring either. A midlife crisis was in the wings and I had no
idea how my passion for the medical profession could be restored. So back in
2005, I was looking for a new challenge when Ralph first approached me to write
a book . I even agreed after he told me the zany title, “Invasion of the Prostate Snatchers.”Fortunately,
when Ralph invited me to be a cowriter, he didn’t give a second thought to the
paucity of writing skills.(Ralph has so
much confidence in his own writing skills he believes he could train a monkey
to write). Over the next four years we clashed on many occasions. Considering that
English was my worst subject in school I have to give myself some credit for
having the courage to accept his proposal.Back
then I had little interest I had in developing the craft of writing.Writing is hard to do.In addition, with limited free time in a busy
medical practice, it’s no surprise that developing writing skills was a low
priority to me. But I was also starting to get upset about the injustice of so
many men’s sexual identities being robbed by unnecessary surgery.The dawning realization, that men, rather
than being helped by surgery are actually being tremendously harmed, is what
motivated me to finally confront the painful task of developing some writing
skills so I could convey my observations to the naïve and unsuspecting patients.
Thank God I had Ralph to tutor me along through this long and arduous journey.Learning
to write about topics that matter to me (such as saving men from the loss their
sexual identity) has saved me from the “meaningless” philosophical wandering
that characterizes a midlife crisis. And as I get older and further polish my
writing skills, I have enjoyed even more satisfaction by helping men to avoid
numerous medical pitfalls. For example, in my next blog I’ll be exposing another
incredibly repugnant policy—men on Active Surveillance who have 12 large
needles plunged through their rectal wall into the prostate gland every year.
Yikes!In
the meantime, let me express my genuine appreciation to Ralph for having the
patience and skill to draw me down this totally unexpected pathway. At this
point I am happy to report that I see no hint of an existential crisis looming on
the horizon.

Tuesday, September 29, 2015

In the old model of prostate cancer care, you were rushed into
radical treatment--usually surgery or radiation--often without
fully understanding all your options, or the risks and side effects
involved. The entire process was focused on the tumor; minimal attention was
given to you as a person, and little effort was made to explore the benefits of
healthy lifestyle choices, immune-enhancing treatments, reasonable delays, and
emotional support.

The emerging new model of prostate cancer care recognizes the
important role you can, and should, play in your recovery. The emerging model
comprehends that simply attacking the cancer is not enough. Greg Anderson, who
after surviving "terminal" lung cancer founded the Cancer Recovery Foundation, has said
that "Retaining a medical team without doing everything you can to help
yourself is like attempting to walk on one stilt."

So what do you need to know in order to take charge of your
recovery?

There are three common misperceptions about prostate cancer:

*The
assumption that the disease is as dangerous as other cancers.

*The
assumption that the urologist who did your biopsy is a prostate cancer expert.

*The
assumption that a quick treatment decision is necessary before the
cancer spreads.

First of all, prostate cancer is unique among cancers because the
mortality rate is so low. Around two hundred thousand men in the U.S. alone are
diagnosed with the disease every year, and less than 15% will eventually die
from it, usually over a decade down the line, while a majority of men who have
the far more common low-risk, slow-growing prostate cancer can anticipate
living a normal life span, or dying of something else.

Your local urologist has a busy medical practice that involves
treating problems like impotence, infections, incontinence, and kidney stones.
He also does biopsies. But the average urologist performs fewer than five prostate removals (prostatectomies)
a year--far too few to be considered proficient. He may be a talented doctor,
but he is unlikely to be a prostate cancer expert. So once you have your biopsy
results, it is best to consult a prostate cancer specialist, either at a major
medical center, or at a high-volume prostate cancer clinic.

As for the third misperception, it is essential, before committing
to any form of treatment, that you do your own research, and are
convinced the treatment you choose is the right one for you. Do not
let anyone rush you into making a bad decision. Once your category of prostate
cancer is identified (Low, Intermediate,
orHigh Risk), get on the
Internet and learn about every treatment option--including no treatment
whatsoever--for your type of disease. If you are over 70, and have
low-risk disease, my advice to you is to find a doctor who has experience
monitoring an active surveillance protocol.

Your role in your recovery, however, doesn't end with choosing
your treatment. The emphasis on lifestyle changes has been one of the most
significant shifts in cancer care in the last decade. A study at UCSF showed
that improving your nutrition, reducing stress and getting more exercise, can
lower PSA levels. And according to a relatively new field of health
psychology called "illness representation," your beliefs and
expectations also impact the outcome of your disease. So take charge of your
recovery, andhave faith in your
choice of treatment.

Tuesday, September 22, 2015

When you are diagnosed with prostate cancer,
keeping a folder with all your medical records can be a challenge, especially
when you are working with several doctors and addressing different health
concerns. But that is also when it is most important, both for your own
understanding and safety, and for the use of any specialists you might want to
consult for a second opinion.

The following is a list of the variety of information
you need to preserve in your medical folder (MMF):

* A Chronological Log of all your PSA
tests with dates, and note in the log any general health changes that might
impact your PSA.

* A copy of your Biopsy Pathology
Report. This should provide your Gleason Score, how many cores were positive
for cancer, the extent of disease in the cores, and the location of the cancer
in the prostate gland.

* Copies of the radiology reports
of any scans (color Doppler ultrasound, bone, CT, MRI), and if available,
digital copies of the actual scans.

* Copies of all information
regarding your medical history, including any current (unrelated to the
prostate cancer) health problems you may be dealing with, even if they seem
minor.

*A
list of all your medications (including the dosages), and a list of any
over-the-counter supplements you are taking.

It is also wise to retrieve your biopsy
slides from the pathologist and send them to a world-class cancer treatment
center, such as MD Anderson, Johns Hopkins, Sloan Kettering, Saint John's, for a second
opinion. In fact if you live in a small town or in the country, if possible you
should get yourself to a urologist or oncologist specializing in prostate
cancer at one of the major centers for a consultation before making a treatment
decision.

Keeping this medical record not only gives
you a feeling of control, but it is extremely helpful when you consult
different specialists. It is also something your partner can help you create.
Giving your partner something constructive to do can help her (or him) deal
with the worry they inevitably feel over your diagnosis.

I personally feel very strongly about the
importance of keeping and organizing all your medical information when dealing
with prostate cancer because I didn't do it. And I know how often I and my
doctors have found the MMF invaluable support. Truly, we are partners with our
oncologists and our urologists. Be an
active partner.

Tuesday, September 15, 2015

Every
year’s Conference presents recurring themes.This year’s focus was prevention, combination treatment and timeliness
were emphasized. We live in an era of exploding technological progress. It is a
delightful problem to have a wealth of new treatment options and diagnostic
tools.However, just like buying a new
car or a new smart phone, it takes a little time to learn the ropes and fully
exploit the complete range and capabilities of the new technology.A short blog can’t cover everything from a
three-day conference.Here are a few
comments.

Dr.
Dan Margolis, an expert on prostate imaging from UCLA, presented information on
3 Telsa, multi-parametric MRI’s capacity as a substitute for random needle
biopsy in men with elevated PSA who have never been previously diagnosed with
prostate cancer.MRI offers the
advantage of being equally or more accurate than random biopsy without relying
on invasive techniques.

Dr.
Chuck Drake, from John Hopkins, the preeminent expert in the world on immune
therapy for prostate cancer, presented exciting data on how many of the new
immune drugs work synergistically when given in combination.“Synergism” means that when either drug is
given by itself the anticancer effect is rather modest.But when the two drugs are given in
combination, the anticancer effect is multiplied.Provenge has already been FDA approved for prostate cancer.Hopefully Yervoy will also be an approved indication for prostate cancer in the
next six to 12 months.The combination
of these two drugs together offers immense hope for jumpstarting immunologic
treatment for prostate cancer.

Dr.
John Mulhall, the expert in the world on sexuality and prostate cancer from
Memorial Sloan Kettering, spent a lot of time emphasizing mindfulness in the selection
of treatment. In other words, he was saying that it is better to minimize damage
by selecting the least toxic form of prostate cancer treatment than trying to
fix an already established problem.

Dr.
Peter Grimm, sometimes called “The Father of Seed Implant Therapy,” delivered a
candid overview of the world of radiation therapy, emphasizing the improved
cure rates and reduced toxicity seed implant therapy offers.He also spoke on how increased financial
incentives to do IMRT, Proton therapy and SBRT, distorts the decision making
process and slants treatment away from seed implants.

This
is only the briefest of overviews and no words can express all the fun and
games that Dr. Mark Moyad injected into the proceedings. I can only say that
initial feedback from the attendees was extremely positive.

2015
PCRI Conference DVDs, which include all the presentations, will be available in
six weeks at a suggested donation of $150. For more information, email: info@pcri.org. In
addition, the PCRI will be presenting its second annual Mid-Year Update, March
26, 2016, an afternoon of educational sessions in developments in the prostate
cancer world. Laurence Klotz, MD who has been called “The Father of Active
Surveillance” will be one of the speakers. Learn more at: www.pcri.org/2016-mid-year-update

Wednesday, September 9, 2015

RALPH BLUMIn the
old model of prostate cancer care, you were rushed into radical treatment--usually
surgery or radiation--often without fully understanding all your options,
or the risks and side effects involved. The entire process was focused on the
tumor; minimal attention was given to you as a person, and little effort was
made to explore the benefits of healthy lifestyle choices, immune-enhancing
treatments, reasonable delays, and emotional support.

The
emerging new model of prostate cancer care recognizes the important role you
can, and should, play in your recovery. The emerging model comprehends that
simply attacking the cancer is not enough. Greg Anderson, who after surviving
"terminal" lung cancer founded the
Cancer Recovery Foundation, has said that "Retaining a medical team
without doing everything you can to help yourself is like attempting to walk on
one stilt."

So what
do you need to know in order to take charge of your recovery?

There are
three common misperceptions about prostate cancer:

*The
assumption that the disease is as dangerous as other cancers.

*The
assumption that the urologist who did your biopsy is a prostate cancer expert.

*The
assumption that a quick treatment decision is necessary before the
cancer spreads.

First of
all, prostate cancer is unique among cancers because the mortality rate is so
low. Around two hundred thousand men in the U.S. alone are diagnosed
with the disease every year, and less than 3% will eventually die from it, while
a majority of men who have the far more common low-risk, slow-growing prostate
cancer can anticipate living a normal life span, or dying of something else.

Your
local urologist has a busy medical practice that involves treating problems
like impotence, infections, incontinence, and kidney stones. He also does
biopsies. But the average urologist performs fewer than five prostate removals (prostatectomies) a year--far too few to be considered
proficient. He may be a talented doctor, but he is unlikely to be a prostate
cancer expert. So once you have your biopsy results, it is best to consult a
prostate cancer specialist, either at a major medical center, or at a
high-volume prostate cancer clinic.

As for
the third misperception, it is essential, before committing to any form of
treatment, that you do your own research, and are convinced the treatment
you choose is the right one for you. Do not let anyone rush you into
making a bad decision. Once your category of prostate cancer is identified (Low, Intermediate, orHigh Risk), get on the Internet and
learn about every treatment option--including no treatment whatsoever--for your
type of disease. If you are over 70, and have low-risk disease, my
advice to you is to find a doctor who has experience monitoring an active
surveillance protocol.

Your role
in your recovery, however, doesn't end with choosing your treatment. The
emphasis on lifestyle changes has been one of the most significant shifts in
cancer care in the last decade. A study at UCSF showed that improving your
nutrition, reducing stress and getting more exercise, can lower PSA levels. And
according to a relatively new field of health psychology called "illness
representation," your beliefs and expectations also impact the outcome of
your disease. So take charge of your recovery, andhave faith in your choice of treatment.

Tuesday, September 1, 2015

BY MARK SCHOLZ, MDPCRI’s Prostate Cancer Conferencefor Patients is
less than two weeks away.The Conference
is a unique event giving opportunity for patients to interact closely with
experts in prostate cancer and leaders in research.It is also a great venue to establish a connection
with other patients who have “been there and done that.” This is a weekend to
stay informed about the latest in prostate cancer.

That’s where
the invited experts come in - we ask them to present their lectures in a way
that can be understood by patients. This year’s program will stress breakthroughs
in imaging, immunology, new hormone therapy, expanded roles for chemotherapy
and the latest thinking on radiation. The
Saturday program will include:

Dr. Mark Moyad, our moderator, will also be speaking about supplements and diet and how
they can lead to increased survival and better quality of life.

Cancer care
is advancing so rapidly that it takes a team effort between you and your
physician to achieve the best care. For the average patient it is overwhelming
to try to stay up to date with the latest clinical studies, journal articles
and protocols. Often the best place for information is an event like this that
specializes in distributing the latest information in a digestible format.

On Sunday morning, most of our Saturday speakers will participate in a smaller group setting and review their presented topics. The conference will end with a speaker
roundtable to see what treatment the experts will recommend when confronted
with actual patient situations.

The PCRI
Conference is for your empowerment. We want it to give you hope and a new
confidence in facing the challenging tasks of making important treatment decisions
that will impact you for the rest of your life.

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PROSTATE SNATCHER VIDEOS

MARK SCHOLZ, MD

Mark Scholz, MD is board certified in medical oncology and internal medicine. He has been treating men with prostate cancer exclusively since 1995. He is the Medical Director of Prostate Oncology Specialists, Inc., and Executive Director of the Prostate Cancer Research Institute. He is an acknowledged expert on management and treatment for prostate cancer using hormone intervention, immunotherapy, chemotherapy and angiogenesis as well as vitamin, herbal and other forms of lifestyle counseling. His affiliations include St. John's Health Center, Marina del Rey Hospital and others. Dr. Scholz also served as an associate clinical professor in the department of Oncology at USC School of Medicine. Dr. Scholz volunteers for the Internet list “Patient to Physician,” found via Resources at www.pcri.org . You may also find current posts on twitter. www.twitter.com/markscholzmd

RALPH H. BLUM

Ralph H. Blum is a cultural anthropologist and author, graduated Phi Beta Kappa from Harvard University with a degree in Russian Studies. His reporting from the Soviet Union, the first of its kind for The New Yorker (1961—1965), included two three-part series on Russian cultural life. He has written for various magazines, among them Reader’s Digest, Cosmopolitan, and Vogue. Blum has published three novels and five nonfiction books. He has been living with prostate cancer, without radical intervention, for twenty years.

PROSTATE ONCOLOGY SPECIALISTS

Established in 1995, Prostate Oncology Specialists has earned national acclaim for its comprehensive approach to prostate cancer prevention and management. Under the direction of Medical Director Mark Scholz, M.D., Prostate Oncology Specialists employs a highly skilled team of physicians trained in oncology, radiology, hematology, and internal medicine who treat all stages of prostate cancer. Prostate Oncology Specialists are not wedded to any single therapy for prostate cancer, but rather advocate the exploration of treatment options that are customized and tailored to the unique needs of each individual patient. Treatments employed include active surveillance, testosterone deprivation, partial cryotherapy, seed implantation, intensity-modulated radiation, and surgery. Prostate Oncology Specialists’ ongoing mission is to uncover new medical breakthroughs in the treatment and management of prostate cancer.

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Please consult your health care provider, or contact Prostate Oncology Specialists, Inc. for an appointment, before making any healthcare decisions or for guidance about a specific medical condition. Prostate Oncology Specialists, Inc. expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site. Information on this site may from time to time be changed or supplemented by Prostate Oncology Specialists, Inc.